title: Breast cancer screening utilization among Eastern European immigrant women worldwide: a systematic literature review and a focus on psychosocial barriers.
abstract: OBJECTIVE
  Many countries host growing Eastern European immigrant communities whose breast cancer preventive behaviors are largely unknown. Thus, we aimed to synthesize current evidence regarding secondary prevention via breast cancer screening utilized by that population.
  
  
  METHODS
  All observational, general population studies on breast cancer screening with Eastern European immigrant women and without any country, language, or age restrictions were identified. Screening modalities included breast self-examination, clinical breast examination, and mammography.
  
  
  RESULTS
  The selected 30 studies were published between 1996 and 2013 and came from Australia, Canada, Denmark, Germany, Israel, the Netherlands, Spain, Switzerland, the UK, and the USA. The reported prevalence of monthly breast self-examination was 0-48%; for yearly clinical breast examination 27-54%; and for biennial mammography 0-71%. The substantial methodologic heterogeneity prevented a meta-analysis. Nonetheless, irrespective of host country, healthcare access, or educational level, the findings consistently indicated that Eastern European immigrant women underutilize breast cancer screening largely because of insufficient knowledge about early detection and an external locus of control regarding decision making in health matters.
  
  
  CONCLUSIONS
  This is a vulnerable population for whom the implementation of culturally tailored breast cancer screening programs is needed. As with other underscreened immigrant/minority groups, Eastern European women's inadequate engagement in prevention is troublesome as it points to susceptibility not only to cancer but also to other serious conditions for which personal action and responsibility are critical.
authors.affiliation: UREN, University of Paris, Bobigny, 93017, France.
authors.forename: Valentina A
authors.initials: VA
authors.lastname: Andreeva
authors.forename: Pallav
authors.initials: P
authors.lastname: Pokhrel
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology; D016504:Breast Self-Examination / Q000523:psychology / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000523:psychology / Q000706:statistics & numerical data*; D004522:Educational Status; D054242:Emigrants and Immigrants / Q000523:psychology / Q000706:statistics & numerical data*; D005061:Europe, Eastern / Q000208:ethnology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007389:Internal-External Control; D008327:Mammography / Q000523:psychology / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010808:Physical Examination / Q000523:psychology / Q000706:statistics & numerical data
keywords: breast neoplasms; cancer; immigrants; oncology; screening